QUANTITATIVE ANALYSIS OF EXTRACAPSULAR EXTENSION OF METASTATIC LYMPH NODES AND ITS SIGNIFICANCE IN RADIOTHERAPY PLANNING IN HEAD AND NECK SQUAMOUS CELL CARCINOMA

Purpose: We performed a histopathologic analysis to assess the extent of the extracapsular extension (ECE) beyond the capsule of metastatic lymph nodes (LN) in head and neck cancer to determine appropriate clinical target volume (CTV) expansions. Methods and Materials: All tumor-positive IN of 98 patients who underwent a neck dissection with evidence of ECE in at least one LN were analyzed by a single pathologist. The largest diameters of all LN, and in the case of ECE, the maximal linear distance, from the capsule to the farthest extent of tumor or tumoral reaction were recorded. Results: A total of 231 LN with ECE and 200 tumor-positive IN without ECE were analyzed. The incidence of ECE was associated with larger IN size (p <0.001). Of all tumor-positive LN with a diameter of < 10 mm or <5 mm, 105/220(48%) nodes or 17/59(29%) nodes, respectively, showed evidence of ECE. The mean and median extent values of ECE were 2 and 1 mm (range, 1-10 mm) and the ECE was <= 5 mm in 97% and <= 3 mm in 91% of the IN, respectively. Overall, the extent of ECE was significantly correlated with larger IN size (Spearman's correlation coefficient = 0.21; p = 0.001). Conclusions: The incidence of ECE is associated with larger IN size. However, ECE is found in a substantial number of LN with a diameter of < 10 nun. The use of 10-mm CTV margins around the gross tumor volume seems appropriate to account for ECE in radiotherapy planning of head and neck cancer. (C) 2010 Elsevier Inc.